Provider Demographics
NPI:1275603623
Name:DAVIS, URIEL T (DO)
Entity Type:Individual
Prefix:DR
First Name:URIEL
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:URIEL
Other - Middle Name:T
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NEUROLOGIST
Mailing Address - Street 1:175 JERICHO TPKE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4532
Mailing Address - Country:US
Mailing Address - Phone:516-496-9292
Mailing Address - Fax:516-496-4240
Practice Address - Street 1:175 JERICHO TPKE
Practice Address - Street 2:SUITE 221
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4532
Practice Address - Country:US
Practice Address - Phone:516-496-9292
Practice Address - Fax:516-496-4240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1435492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70D921Medicare ID - Type UnspecifiedPROVIDER NUMBER